Is the neglect of exercise in anorexia nervosa research a case of “running out” of ideas or do we need to take a “LEAP” of faith into the future?

Abstract

The most recently published clinical practice guidelines for the treatment of eating disorders [6] emphasized how important it was for clinicians to pay specific attention to over-exercise when assessing their adolescent patients presenting with AN. With an array of terminology (e.g., “excessive exercise, “compulsive exercise”, “obligatory exercise”, “driven exercise”) describing various aspects of physical activity in clinical and research settings, Noetel and colleagues [4] sought to canvass opinions from the leading clinicians/scientists in the field of adolescent eating disorders to settle on one term to describe this phenomenon. Carrera and colleagues go on to say, “Consistent with recent research with an analogous animal model of the disorder, our findings suggest that ambient temperature is a critical factor contributing to the expression of excessive physical activity levels in AN” [8]. The results to date have been promising in adult patients with AN as those who have completed it have reported improvements in avoidance and rule driven exercise behavior, less use of exercise as a weight control strategy and a more flexible approach (less rigidity) towards exercise in general [13]. Since there is now emerging evidence that interventions that specifically target over-exercise in patients with AN can be clinically effective in reducing this worrisome behavior (which is often the last symptom to resolve), there is an urgent need for researchers in the field to address this, particularly within an adolescent population.